Provider Demographics
NPI:1528113073
Name:FREY, SARA LYNNE (LMP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LYNNE
Last Name:FREY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:LYNNE
Other - Last Name:LUGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:491 RESERVE WAY
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0703
Mailing Address - Country:US
Mailing Address - Phone:509-301-4363
Mailing Address - Fax:
Practice Address - Street 1:491 RESERVE WAY
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-0703
Practice Address - Country:US
Practice Address - Phone:509-301-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016076174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist